Provider Demographics
NPI:1124364013
Name:HAYDEN, WENDI LYN
Entity Type:Individual
Prefix:
First Name:WENDI
Middle Name:LYN
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:470 BRINGHURST CIR
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:UT
Mailing Address - Zip Code:84332-9438
Mailing Address - Country:US
Mailing Address - Phone:435-754-4735
Mailing Address - Fax:
Practice Address - Street 1:470 BRINGHURST CIR
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:UT
Practice Address - Zip Code:84332-9438
Practice Address - Country:US
Practice Address - Phone:435-754-4735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency